Brazilian Journal of Anesthesiology最新文献

{"title":"Serratus posterior superior intercostal plane block versus thoracic paravertebral block for pain management after video-assisted thoracoscopic surgery: a randomized prospective study","authors":"Güvenç Doğan ,&nbsp;Onur Küçük ,&nbsp;Selçuk Kayır ,&nbsp;Gökçe Çiçek Dal ,&nbsp;Bahadır Çiftçi ,&nbsp;Musa Zengin ,&nbsp;Ali Alagöz","doi":"10.1016/j.bjane.2025.844647","DOIUrl":"10.1016/j.bjane.2025.844647","url":null,"abstract":"<div><h3>Background</h3><div>Video-Assisted Thoracoscopic Surgery (VATS) is a minimally invasive procedure associated with faster recovery and fewer complications compared to open thoracotomy. Effective postoperative pain management is important for optimizing recovery. This study compares the analgesic efficacy of the Serratus Posterior Superior Intercostal Plane Block (SPSIPB) and Thoracic Paravertebral Block (TPVB) for postoperative pain following VATS.</div></div><div><h3>Methods</h3><div>In this randomized, prospective, double-blind study, 70 patients aged 18–65 years (ASA I–III) undergoing VATS were randomly assigned to Group TPVB (n = 35) or Group SPSIPB (n = 35). The primary outcome was the 24-hour postoperative Visual Analog Scale (VAS) pain score at rest. Secondary outcomes included VAS pain scores during coughing, time to first opioid request, total opioid consumption within 24 hours, patient satisfaction, and Quality of Recovery-15 (QoR-15) scores. Opioid consumption was assessed using intravenous tramadol through Patient-Controlled Analgesia (PCA), with additional morphine, if required.</div></div><div><h3>Results</h3><div>The mean age of the patients was 52 ± 11 years, and 64.2% were male. VAS pain scores were evaluated at 24 hours and at seven time points. There was no significant difference between groups (p &gt; 0.05) except at 1 hour postoperatively, where the TPVB group had a significantly lower resting VAS score (19 [8–28] vs. 26 [18.5–33], p = 0.031). The total 24 hour tramadol consumption was 220 mg (135–260) in the TPVB group versus 150 mg (110–230) in the SPSIPB group (p = 0.129). The proportion of patients requiring additional analgesia was 25.7% in the TPVB group versus 28.5% in the SPSIPB group (p = 0.788). Preoperative and postoperative QoR-15 scores were similar between the groups (preoperative: 137 vs. 136, p = 0.878; postoperative: 133 vs. 132, p = 0.814). Patient satisfaction scores were also comparable (8 [7–10] vs. 9 [7–10], p = 0.789).</div></div><div><h3>Conclusion</h3><div>SPSIPB provides analgesic efficacy similar to TPVB for VATS, with comparable pain scores, opioid consumption, and recovery outcomes. Given its ease of use and safety profile, SPSIPB represents a promising alternative to TPVB in multimodal analgesia for minimally invasive thoracic surgery.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844647"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging classification in videolaryngoscopy: are we on the right track?","authors":"Daniel Perin,&nbsp;Mauricio Luiz Malito,&nbsp;Maurício do Amaral Neto","doi":"10.1016/j.bjane.2025.844671","DOIUrl":"10.1016/j.bjane.2025.844671","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844671"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracic wall blocks in cardiac and thoracic procedures: expanding frontiers for perioperative regional analgesia","authors":"Marcello Fonseca Salgado-Filho ,&nbsp;Luiz Guilherme Villares da Costa ,&nbsp;Eric Benedet Lineburger ,&nbsp;Bruno Francisco de Freitas Tonelotto","doi":"10.1016/j.bjane.2025.844670","DOIUrl":"10.1016/j.bjane.2025.844670","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 5","pages":"Article 844670"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Goal-directed therapy with continuous SvcO2 monitoring in pediatric cardiac surgery: the PediaSat single-center randomized trial","authors":"Flavio M. Ferreira,&nbsp;David D. Araujo,&nbsp;Gustavo M. Dantas,&nbsp;Ligia Cristina C. Cunha,&nbsp;Suely P. Zeferino,&nbsp;Filomena B. Galas","doi":"10.1016/j.bjane.2025.844614","DOIUrl":"10.1016/j.bjane.2025.844614","url":null,"abstract":"<div><h3>Introduction</h3><div>Low Cardiac Output Syndrome (LCOS) remains a significant perioperative challenge in pediatric cardiac surgery. This study evaluated whether a hemodynamic protocol aimed at optimizing continuous central venous Oxygen Saturation (SvcO₂) using the PediaSat catheter could reduce postoperative complications in pediatric patients undergoing congenital heart surgery.</div></div><div><h3>Methods</h3><div>Conducted at the Instituto do Coração in São Paulo, this randomized clinical trial compared a group receiving SvcO₂-based goal-directed therapy via PediaSat (intervention) against conventional care (control). The main objective was assessing 24-hour lactate clearance post-surgery, with secondary outcomes including Vasoactive-Inotropic Score (VIS), Mechanical Ventilation (MV) duration, vasopressor use, and ICU/hospital stay lengths.</div></div><div><h3>Results</h3><div>From July 13, 2014, to March 17, 2016, 391 patients were evaluated for eligibility. After applying inclusion and exclusion criteria, 65 patients were included and randomized ‒ 33 to the control group and 32 to the PediaSat group. There were no losses to follow-up in either group. Lactate clearance did not significantly differ between the intervention and control groups. However, the PediaSat group showed significantly shorter mechanical ventilation times, reduced vasopressor use, and shorter ICU stays. No significant differences were observed in hospital stay length or incidence of postoperative complications between the group.</div></div><div><h3>Conclusions</h3><div>While optimizing SvcO₂ did not affect overall lactate clearance, it was associated with shorter MV duration, decreased vasopressor need, and shorter ICU stays in pediatric cardiac surgery patients. These findings highlight the potential benefits of continuous SvcO₂ monitoring in postoperative care.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844614"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of anesthesiology residents in the diagnosis and control of malignant hyperthermia: comparison of three scenarios of realistic simulation ‒ a cross-sectional controlled study","authors":"Mariana F.L. Neville ,&nbsp;Victor Guimarães de Almeida ,&nbsp;Pamela Vieira Andrade ,&nbsp;Joilson Moura Santos ,&nbsp;Masashi Munechika ,&nbsp;David Ferez ,&nbsp;Mary dos Santos Silva ,&nbsp;Leonardo Ayres Canga ,&nbsp;Ana Cristina Tripoloni ,&nbsp;Thierry Girard ,&nbsp;Helga Cristina Almeida da Silva","doi":"10.1016/j.bjane.2025.844615","DOIUrl":"10.1016/j.bjane.2025.844615","url":null,"abstract":"<div><h3>Introduction</h3><div>Simulation-based training is particularly beneficial for rare and life-threatening diseases such as Malignant Hyperthermia (MH). In addition, cognitive aids, including flowcharts and checklists, can be used as guidance in crisis, reducing cognitive demand and simplifying patient care. We assessed the technical and non-technical performance of anesthesiology residents when diagnosing and treating a hypothetical case of MH in three different scenarios.</div></div><div><h3>Methods</h3><div>This was an observational, cross-sectional, and controlled study. Pairs of anesthesiology residents participated in a validated high-fidelity MH realistic simulation in one of three different scenarios: 1) Control (no access to cognitive aids), 2) Poster, or 3) Mobile application. Both poster and mobile application provided a flowchart and information related to MH diagnosis and treatment. Demographic data, perceived stress levels, and technical and non-technical skills were registered and compared among the groups.</div></div><div><h3>Results</h3><div>Thirty residents (5-pairs for each scenario) participated in the simulations. The mean score in the technical skill survey was significantly higher in the poster and mobile application groups compared with the control group (83 [4.4], 83 [3.8], and 74 [8.2], respectively, ANOVA, p = 0.047). A significantly higher score for non-technical skills was also found for the poster and mobile application groups compared with the control group (55 [2.5], 57 [0.8], 52 [2.1], respectively, ANOVA, p = 0.03).</div></div><div><h3>Conclusion</h3><div>In a realistic high-fidelity MH simulation, the participants had satisfactory performance regarding technical and non-technical skills. However, the groups with access to cognitive aids achieved better scores, with no difference between the groups with access to the MH poster and the MH mobile application.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844615"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant hyperthermia and surnames: ethical dilemmas and diagnostic pitfalls","authors":"Helga Cristina Almeida da Silva ,&nbsp;Maria Anita Costa Spindola ,&nbsp;José Luiz Gomes do Amaral","doi":"10.1016/j.bjane.2025.844622","DOIUrl":"10.1016/j.bjane.2025.844622","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844622"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Keeping it in the family: Malignant Hyperthermia - how we predict, recognise and treat it","authors":"Jonathan G. Bilmen,&nbsp;Pawan K. Gupta","doi":"10.1016/j.bjane.2025.844645","DOIUrl":"10.1016/j.bjane.2025.844645","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844645"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of PEEP on lung aeration in pediatric patients after cardiac surgery: a CT-Based study","authors":"Solange C. Gimenez ,&nbsp;Milene C. Carrilho ,&nbsp;Isabela M. Malbouisson ,&nbsp;Marcelo Gama de Abreu ,&nbsp;Jean-Jacques Rouby ,&nbsp;Luiz Marcelo Sá Malbouisson","doi":"10.1016/j.bjane.2025.844623","DOIUrl":"10.1016/j.bjane.2025.844623","url":null,"abstract":"<div><h3>Background</h3><div>Loss of lung aeration is frequently observed in adult patients following cardiac surgery with cardiopulmonary bypass. Yet, in children, changes in lung aeration following surgical repair of congenital heart defects, and the effects of Positive End-Expiratory Pressure (PEEP), remain uncertain.</div></div><div><h3>Methods</h3><div>Changes in lung aeration were investigated using volumetric computed tomography in 12 children with congenital acianogenic heart diseases and increased pulmonary flow who underwent total surgical repair under cardiopulmonary bypass. Computed tomography of the lungs was obtained preoperatively during spontaneous breathing and postoperatively during mechanical ventilation with positive end-expiratory pressure of 0, 5 and 10 cm H₂O. Gas and tissue lung volume and mass, as well non-aerated, poorly aerated and normally aerated lung compartments were measured.</div></div><div><h3>Results</h3><div>Median age of patients was 18.3 months, (4 to 24 months), weight was 9.3 ± 2.3 kg. Cardiopulmonary bypass duration was 77 ± 26 minutes. Preoperatively, pulmonary volume was 545 mL (237‒753 mL), whereby tissue and gas volumes were 48.4% (41.7%‒59.6%), and 51.6% (40.4%‒58.3%), respectively. Non-aerated and normally aerated compartments accounted for 15% and 47.9% of lung tissue, respectively. Postoperatively, at zero PEEP, the non-aerated compartment increased to 27%, while normally-aerated compared decreased to 38.5%. Stepwise PEEP application restored normally aerated lung volume to preoperative levels but did not significantly reduce non-aerated parenchyma.</div></div><div><h3>Conclusion</h3><div>Loss of lung aeration was pronounced after surgical correction of congenital heart defects. PEEP up to 10 cm H₂O restored gas volume but failed to recruit the collapsed parenchyma. Ethical Approval CAPPesq n° 854/01.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844623"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and risk factors for acute kidney injury after cardiac surgery in a Brazilian University Hospital: a retrospective cross-sectional study","authors":"Pedro Victor Fernandes Ferreira ,&nbsp;Heitor J.S. Medeiros ,&nbsp;Hugo de Santana Ribeiro Dantas ,&nbsp;Eduardo Venancio Teixeira ,&nbsp;Lucas Pereira Trevisan ,&nbsp;Fernanda de Castro Teixeira ,&nbsp;Fernanda Cunha Soares ,&nbsp;Raphael Klênio Confessor de Souza ,&nbsp;Wallace Andrino da Silva","doi":"10.1016/j.bjane.2025.844635","DOIUrl":"10.1016/j.bjane.2025.844635","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844635"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous saturation guided postoperative care for pediatric cardiac surgical patients: the body wants oxygen!","authors":"Rohit S. Loomba","doi":"10.1016/j.bjane.2025.844641","DOIUrl":"10.1016/j.bjane.2025.844641","url":null,"abstract":"","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 4","pages":"Article 844641"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}